title: Reasons for the persistence of adverse events in the era of safer surgery--a qualitative approach.
abstract: OBJECTIVE
  We sought to evaluate potential reasons given by board-certified doctors for the persistence of adverse events despite efforts to improve patient safety in Switzerland.
  
  
  BACKGROUND
  In recent years, substantial efforts have been made to improve patient safety by introducing surgical safety checklists to standardise surgeries and team procedures. Still, a high number of adverse events remain.
  
  
  METHODS
  Clinic directors in operative medicine in Switzerland were asked to answer two questions concerning the reasons for persistence of adverse events, and the advantages and disadvantages of introducing and implementing surgical safety checklists. Of 799 clinic directors, the arguments of 237 (29.7%) were content-analysed using Mayring's content analysis method, resulting in 12 different categories.
  
  
  RESULTS
  Potential reasons for the persistence of adverse events were mainly seen as being related to the "individual" (126/237, 53.2%), but directors of high-volume clinics identified factors related to the "group and interactions" significantly more often as a reason (60.2% vs 40.2%; p = 0.003). Surgical safety checklists were thought to have positive effects on the "organisational level" (47/237, 19.8%), the "team level" (37/237, 15.6%) and the "patient level" (40/237, 16.9%), with a "lack of willingness to implement checklists" as the main disadvantage (34/237, 14.3%).
  
  
  CONCLUSIONS
  This qualitative study revealed the individual as the main player in the persistence of adverse events. Working conditions should be optimised to minimise interface problems in the case of cross-covering of patients, to assure support for students, residents and interns, and to reduce strain. Checklists are helpful on an "organisational level" (e.g., financial benefits, quality assurance) and to clarify responsibilities.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital Bern University Hospital, Switzerland; kaderli@hispeed.ch.
authors.forename: Reto
authors.initials: R
authors.lastname: Kaderli
authors.forename: Julia  C
authors.initials: J
authors.lastname: Seelandt
authors.forename: Melika
authors.initials: M
authors.lastname: Umer
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.forename: Adrian  P
authors.initials: A
authors.lastname: Businger
mesh_terms: D001291:Attitude of Health Personnel; D057189:Checklist; D002983:Clinical Competence; D006295:Health Resources; D006761:Hospitals; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control / Q000523:psychology*; D015279:Organizational Culture; D061214:Patient Safety; D036301:Qualitative Research; D017751:Safety Management; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013557:Switzerland; D014940:Work Schedule Tolerance; D016526:Workload